Celiac Disease Tests Do Not Reflect Ongoing Mucosal Damage, according to meta-analysis

According to a recent meta-analysis of patients with confirmed (via biopsy) celiac disease, the most common tests (serum transglutaminase-tTG and endomysial antibodies-EMA) used to screen for CD as well as monitor healing, are unable to detect persistent small intestinal damage (villous atrophy) in many patients following a gluten-free diet. The researchers concluded more accurate, non-invasive markers of mucosal damage in both children and adults with celiac disease following a gluten-free diet are needed.

(View Abstract here) “In a meta-analysis of patients with biopsy-confirmed celiac disease undergoing follow-up biopsy on a gluten-free diet, we found that tests for serum tTG IgA and EMA IgA levels had low sensitivity (below 50%) in detection of persistent villous atrophy.”

“Although widely available, and relatively non-invasive, serum tTG IgA and EMA IgA antibodies are poorly correlated with mucosal outcomes,” they conclude. “Most patients with celiac disease have negative antibody tests on a gluten-free diet, even those with persistent mucosal damage.”

“A positive test result is helpful as this has good specificity for persistent villous atrophy and signals probable ongoing gluten ingestion,” the authors explain. “Such a finding should prompt dietary assessment and review with a dietitian with expertise in celiac disease. A negative antibody test is much less informative and should not be interpreted as an indicator of mucosal recovery nor as a proxy for gluten-free diet adherence.”